ICU Management of Acute Pulmonary Embolism

Dr. Feras Khan is an emergency medicine trained intensivist who has recently joined the University of Maryland’s departments of both CCM and EM. This is a great lecture on the nuts and bolts of managing the patient with an acute PE in the ICU. Do you know the code dose of t-PA if that PE patient decompensates? Who should be given low-molecular weight heparin (LMWH) vs. unfractionated heparin (UFH)? Who gets an IVC filter? Well, for some of these questions you may only have a minute or two to decide – so if you aren’t sure, take 30 minutes out of your day and get some quality core-content education.

Sustained hypotension defined as a SBP < 90 is an indication for PE thrombolysis. How long is sustained hypotension? 15 Minutes.

The risk of hemorrhagic complications secondary to PE thrombolysis is estimated to be about 20%. ICH post t-PA for pulmonary embolism appears to be around 1-5%.

In patients admitted to the ICU, strongly consider UFH over LMWH for anticoagulation therapy. Specifically use UFH if the patient has any evidence of renal insufficiency/failure, BMI>40, or even a chance that they will need thrombolytics or surgical intervention (i.e. most ICU patients).

If you haven’t read the MOPETT Trial yet, do yourself a favor and invest at least 30 minutes in reading through this study. It may be a practice changing article.